Concussion
| Educator
15th Dec, 2022Podcast

 

Listen on Amazon music | Apple Podcasts Google Podcast | Spotify 

Wendy McLean (00:05):Welcome to Common Ground, a podcast series discussing new research and interesting projects in the field of complementary medicine. Hello, my name is Wendy McLean, Senior Writer and Presenter at vital.ly.

Firstly, I’d like to begin by acknowledging the Gadigal people of the Eora Nation as the traditional custodians on the land on which we gather here. I would also like to pay my respect to their elders, past, present and emerging.

Today I will be talking about a very serious topic with Jo Grabyn, and that is concussion and traumatic brain injuries. Jo Grabyn is a Functional Nutritionist & the owner of Bounce Matters - WHOLE Health Clinic in Manly where she specialises in brain & mental health, using nutritional medicine as a basis for healing alongside other modalities, such as mild hyperbaric oxygen therapy.

Having graduated in 2005, Jo worked through various areas of Nutrition from allergies & food intolerance, to complex chronic stress.  She was in the first group of healthcare professionals to train with Dr Dale Bredesen in the US for reversing cognitive decline and Alzheimer’s in 2016, alongside neurologists, researchers & the senior faculty of the Institute of Functional Medicine (IFM).  

The following year, after attending the IFM conference on neurodegenerative diseases, then Integrative Medicine for Mental Health, also in the US, she was introduced to the issues of numerous or severe concussion / traumatic brain injuries, and a functional medicine approach to working with these patients.  From here, ongoing training with Dr Daniel Amen and his Amen Clinics across America, and the International Hyperbaric Association has allowed her to deepen her knowledge and practice to provide a multidisciplinary, personalised approach to helping patients with post-concussion syndrome in all age groups and all walks of life.

This is somewhat of a personal crusade for Jo, whose Dad and best friend died as a result of the longer-term impacts of a traumatic brain injury around 13 years ago

Welcome to Common Ground, Jo.

Jo Grabyn (02:08):Thanks, Wendy. Thanks for having me.

Wendy McLean (02:10):Jo, this is as I just mentioned a topic that's very close to your heart, and we've touched on this in the introduction, but perhaps you'd like to share a little bit more about your background and how you came to specialise in concussion and traumatic brain injuries.

Jo Grabyn (02:26): Yeah. I think when, so my grandpa actually passed away from Alzheimer's when I was in high school, and that was quite scary watching what happened, and it was always one of those areas of, oh God, you know, you get that diagnosis and there's nothing that you can do about it. And then as I said, about 13 years ago, my dad had quite a serious accident. He spent six weeks in an induced coma, about another four or five months in a brain trauma unit in the Epworth Hospital in Melbourne. And for me to cope with stuff like that, I try to understand. So I sat there and read Norman Doidge’s book, which is ‘The Brain that Changes Itself’ trying to go, okay, this is not over. He's going to come back to me. So and at that point there was, you know, really very little in the natural medicine space.

And then in 2016, actually Metagenics brought Dale Bredesen out here for their Congress. And Dale spoke about a pilot study that he had done in what he was then calling ReCODE, which is the reversing of cognitive decline using metabolic approaches. And he actually noted that he was going to be running a training the following month in the US and I put my hand up and I'm like, is this just for doctors or can naturopaths and nutritionists go too? And it was an application process, so you had to literally explain why you wanted to be a part of it and what you would do with that training, the way you were going to go. So I was incredibly lucky to actually be accepted and not really understanding how lucky until I got there, which was 3000 applicants ended up with 60 people in the room. Six Aussies and six nutritionists in total between Australia and the US. 

And then so that was, that started that project and then the following year I went to the IFM conference which was all different types of neurodegenerative conditions from Alzheimer's, dementia, Parkinson's, through to post-concussion syndrome. And it was, so, it was quite that wow factor of going I didn't realise all of the things that happened with that, and yet looking at it and going, I saw those in my dad after he came home from hospital, but before we lost him. And then I was then introduced to Daniel Amen and went back eight weeks later to ‘Integrative Medicine for Mental Health’. And back then that particular conference was more mental health and a little bit of brain health. And then particularly with Dr Amen doing that, he really moved the needle on the fact that mental health is brain health.

And it sort of started bringing everything together, which made a lot of sense to me. And because that was about the year that I got my first hyperbaric chamber and I need to tread a bit lightly, you know, we've got to be careful about what we say about hyperbaric here in Australia, but mild hyperbaric, although it is at 1.3 atmospheres and is considered a wellness treatment rather than a medical treatment. There’s a lot of research. So that's something people might want to dig into in the background. It's not something that we can talk about online in particular here in Australia, however, there is a lot going on in the space and having been to the conferences in America and meeting some people who have had profound improvement with right through to really incredibly severe brain injuries, you know, it's an interesting area. 

And Daniel Amen, is also the doctor, he was a consulting physician on the movie concussion with Will Smith, which is where they really brought CTE [chronic traumatic encephalopathy] and all of the consequences of that to the forefront. So that's more or less how I got there. And I've just been digging ever since, you know, it's a big area and it's an area I'm passionate about because it's, you know, the risk, the highest risk populations are zero to 17. And then 65 plus. And we do often see that when you've got multiple concussions, it will absolutely trigger mental health issues. Whether you're talking about kids in sport, a kid who's fallen off their bunk bed, or fallen off a slide or, someone who's a veteran who's been in Afghanistan and been blown up and now has a massive brain injury off the back of that.

Wendy McLean (06:52): Yeah, absolutely. Well look, out of heartbreak, you've really turned that around to, you know, do this research and, and, you know, potentially help a lot of other people as well. So, that's fantastic. And I guess that just leads onto now what exactly is a concussion and/or a traumatic brain injury?

Jo Grabyn (07:18): If you actually look at like the American Association of Neurological Surgeons have quite a specific definition around it. Because there's a lot of misconceptions. There's also a lot of misdiagnoses like probably only one in three get diagnosed which is really sad actually, because a lot of people get left feeling like, well, what's wrong with me then if I, you know, if my brain's not actually injured. So their view is that a concussion is the immediate and transient alteration of brain function, including the alteration of mental status and level of consciousness resulting from mechanical force or trauma. So you may not see anything on the outside, you know, like we think about it as being you know, contact sport, it's think whiplash injury, think shaken baby syndrome. You know, our brain's actually pretty soft. It's a similar texture to say, you know, soft butter or even margarine that's been left out of the fridge and the inside of our skull is pretty inhospitable place to something that's that soft and gooey. Like if you left it sitting, it's gross, but if you left it sitting on a bench for an hour or so it would kind of start oozing. 

And you know, I think it's just really important for people to understand that it's, you didn't necessarily get a knock to the head, or you didn't necessarily black out or pass out or lose consciousness. And it can take an extended period of time for the symptoms to show up as well. You know, sometimes like I had a perfect example a few months ago of a young guy who was glassed in the street in Oxford Street, he's actually a rugby player. He spent a lot of time in the hospital overnight on the Saturday night, and they're like, no, you're good. You don't have a concussion. And by lunch time on Monday he was profoundly nauseous, super dizzy, had a terrible headache. He had all the signs and symptoms, but because he'd been sent home and told that he was fine. It just happened to be that he was the partner of someone who knows me very well and she brought him in, and we started him on a nutrition protocol straight away.

It's you know, the suggestion is that around 10% of high school kids that play contact sport get a concussion every year. So whether that be in the moment where it was a major hit or it can actually occur through ongoing microtraumas throughout a season and then equate to the equivalent of a full concussion at the end of the season, or even over a couple of years.

Wendy McLean (09:54): That's quite astounding, that figure. Quite alarming. And I think back to myself, you know, I was a soccer player heading the ball all the time.

Jo Grabyn (10:06): Yeah. One of our long-term post-concussion patients is 17 and he's been a defender in soccer since he was about five. And so yeah, heading the ball is, it's really not good for you.

And you think, we think, well, it's fine. You know, it’s not like rugby where you're getting taken out by the massive person coming running at you. It's par for the course of playing the sport.

Wendy McLean (10:33): Yeah, absolutely. And just all these subtle things that you don't think about. I wouldn't have necessarily equated whiplash with brain injury either. So, I guess it’s that force, as you said, and soft brain matter.

Jo Grabyn (10:47):And also the fact that you know, and this is not sexist. Hey I am female. But women or females actually have slightly softer brain tissue. So our brain is at greater risk, and particularly post-concussion syndrome. And you know, even if you have a background, you know, like high anxiety increases your risk to post-concussion syndrome. A high sugar diet increases your risk to post-concussion syndrome. So there's lots of different things to take into consideration and often the major symptoms that are post may not even land for six to 12 months after the original injury, depending on how many you've had and how it's shown up.

Wendy McLean (11:30): Yeah, absolutely. And I guess now that we've started talking about it, I imagine that concussion is quite common. Do you have any stats around that and some of the other common causes, sports obviously being the big one.

Jo Grabyn (11:46): It's more the stats are in the high school and contact sport. Because there's so many that are undiagnosed, they believe that probably only one in three get diagnosed because you cannot necessarily see a concussion on a CT scan. You're not going to see it on an MRI like unless the brain's bleeding and that is severe brain injury. The functional MRI, which is really not very readily available in Australia, there's a little bit of work going on there. Probably the most honest diagnosis comes off a SPECT scan and we don't really have the SPECT scans that have the right level of clarity on the scans themselves to be able to see it. So a SPECT scan actually looks at blood flow. Normally you do two, a day apart, and one you do at concentration and then the other one you do at rest. And then they can see the differential between where things are. And when you look at those scans the Amen clinic they've really done a lot to improve the technology behind it. You can see parts of the brain where the blood flow is not good or is maybe not even there.

It's an interesting space and it's really sad that here, unless you are bad enough to end up in a hospital, And even then, they will still sometimes say to you, no you're good up here, you'll be fine.

Wendy McLean (13:27): That's tragic. But just on that, so the SPECT scan, so how do they actually do it. I was reading it, they inject something, a tracer or something?

Jo Grabyn (13:41): So I actually had them, I went to the States in June and did a program with the Amen clinic where you are treated as a patient so you can actually understand the whole process. And you go in, they put you in a dark room, like when it's the at rest, they'll put you in a dark room for about 15 minutes. So you just totally zen out. And then they inject a radioactive isotope into your arm. Then you've got another 15 minutes of total zen time. And then you go into the scan, which looks a little bit like a CT. And then when you do the at concentration, they actually have a computer program where you are having to concentrate really hard to keep up with it. But again, in a dark room, they do that for 15 minutes. You have the injection and then you do it for another 15 minutes before you go for the next scan.

And it's interesting looking at the differences between them, because if you would only get one, sometimes it might look like your brain's in a worse place than the other way. It's a pretty noninvasive scan. Providing, you know, your body doesn't react badly to the radioactive isotope.

Wendy McLean (14:54):And so we do have them in Australia, but not to that level of accuracy? 

Jo Grabyn (15:00):  No, they're black and white. I'm actually not sure what the criteria is to get one here. But the Amen clinic have turned them into like quite an amazing rainbow-coloured diagram. So you can really see things very clearly. And it's quite confronting for people who get one of those scans and it looks like there's a big part of their brain missing. You think oh, that's where they did it. And actually those guys have done a couple of hundred thousand scans on the NFL footballers. They do before and after with hyperbaric. They've also done, and I think this is quite interesting, they've done a great percentage of the death row inmates in the US. What they find is that close to a hundred percent of those criminals have brain damage and they're like, it probably happened. You know, they may report that they've never had anything going on, but it's probably come from childhood abuse or a fight somewhere or some sort of issue that has then affected their mental health which is what's their personality. 

Wendy McLean (16:16): That's absolutely fascinating. But it makes sense when you think about it.

Jo Grabyn (16:20): Yeah. It's, and I think it's nice that they had that broad minded approach to go, okay, so this is not just about sport. Well, this is not just about a car accident. It can be around drug and alcohol abuse to some degree because they will reduce blood flow in the brain. But Dr Amen’s been doing this work for like 30 or 40 years, so he now can actually probably figure, like, by through an interview with a patient, take a guess at what they're going to see, and then go and look at it and go, oh, yeah. Whereas originally they started with the scans it went the other way. 

Wendy McLean (16:54): Wow. that's fascinating. So I guess what actually happens to the brain when it sustains a concussion?

Jo Grabyn (17:05): So when the brain gets bounced around in your head, because basically that's what's going on, you know, it's not just, it's not held tight. It, obviously we all know that it sits in CSF [cerebral spinal fluid]. And so there is some movement and I think sometimes what people don't realise, and this became really clear to me with my dad's accident, is he actually landed headfirst on a concrete roundabout. So, but on the back of his head, so his, the fracture was at the back of his head, but all the damage was in his frontal lobe because his brain had bounced. So it ends up very bruised and very damaged. So in the process of that, what happens is that there's brain oedema, it starts swelling, the blood flow is reduced, inflammation starts increasing, free radicals start being formed, the blood brain barrier opens, the gut brain, you know, the gut barrier opens.

So then you've got this crosstalk that shouldn't be happening, which is often why people get, you know, profound nausea and vomiting going on. Because all of these things are going to the brain that's going, no, no, I'm not supposed to normally see these things. Our glutathione levels drop out by anywhere from 30 to 50%. There's profound metabolic dysregulation. So the brain suddenly is really low on energy, but it can't use glucose at this point. It actually needs ketones. It's just, you know, so it's one of the first key things that you want to do with, you know, with the patient is get them off all the sugar and inflammatory type foods. And we need rest. It starts to affect your sleep. It can create visual disturbance, but they're probably the key things that we try to work on as quickly as possible.

Wendy McLean (18:47): Yeah. I find the link, how it affects the gut as well, the link between gut and the brain interesting. 

Jo Grabyn (18:58): But it makes sense, right? When you think about someone gets concussion and suddenly they start to feel really sick. It's like, ah, there you go. There's that gut brain connection again.

Wendy McLean (19:08): Yeah, absolutely. 

Jo Grabyn (19:11): Which is super smart.

Wendy McLean (00:19:11): So there's a lot of things going on and I guess when you can understand that pathophysiology, you can kind of understand why sometimes the symptoms don't appear straight away, you know, in the case of a mild trauma.

Jo Grabyn (19:24): Yeah. So I find the glutathione piece really interesting. How it drops about 50% down almost immediately. And then within about three hours, you know, it's still down about by about 30%. And when you look at the research around NAC and there's some set doses around that. Over 80% of people will improve profoundly within the first seven days if you get them onto the right doses of NAC. So that in itself is knowing that, you know, we really have an important place as natural medicine practitioners because we're the ones that understand the nutrients. 

Wendy McLean (20:06): And yes, I had read some of the studies looking at the veterans with the bomb blast injuries and getting administered the NAC within 24 hours of the trauma. And seeing some good results there. So that's really, that's heartening and positive.

Jo Grabyn (20:24): And it's, I mean NAC's cheap, like when you compare it to giving someone glutathione. It has so many other benefits, you know, so, and it's doable for many people.

Wendy McLean (20:33): Yes. Absolutely. So I think you pretty much covered it, but what are the acute symptoms of concussion? You've mentioned quite a few, the nausea, blurred vision. Are there any other ones that can appear? 

Jo Grabyn (20:48):People like, they can become incoherent with their speech. They get quite confused, so they get quite disorientated. They will become, you know, some of them get quite dizzy, which is why you're like, just sit down for a little while. And sometimes they will be quite really vacant. They can have amnesia off the back of it quite quickly. It's like, got no idea. Sometimes it'll be, I don't actually know what happened in the event, but then sometimes they can actually lose time prior to the event as well.

So we really, we consider it to be, the acute period is the first sort of three to four weeks, but absolutely the first week. Depending on how bad it is. So getting there like straight away, if we, if I had my way, every single sports team that has contact would actually keep a nutritional first aid kit on the sideline with their big box of bandages and ice packs and all the rest of it. It's like, oh, here's a little pack just for the person who got knocked out just now. They have that because they've shown that within 30 minutes you can start improving and helping the brain straight away from an inflammatory point of view.

Wendy McLean (22:07): I mean that would be amazing. Because I’ve certainly watched quite a lot of AFL and some of the horrific clashes that they have had and you see these guys and they're out cold and then they get up play and it's just, that's scary.

Jo Grabyn (22:22): Yeah, it's interesting. In the States they have, you know, in America, not even every state, you have to wear a motorbike helmet, but in every state they have very strict rules around their NFL football in that if they actually do get knocked out, they're out for the game. And it happened off the back of a young teenager who was put back on the field and then he got a second hit and actually ended up with a profound spinal injury. You know, but he, it was years of therapy rather than if they’d just left him off the field and let him rest and let him recover. You know, he wouldn't have, he pretty much lost his life, you know? 

I think it's interesting they've done that and we haven't followed suit.

Wendy McLean (23:06): There’s certainly a long way to go with that. And so we've talked about the acute symptoms, but what are these longer term symptoms or this post-concussion syndrome that you've mentioned?

Jo Grabyn (23:20): Yeah, so I think the first thing to understand is that from a post-concussion syndrome, it means if someone hasn't healed in the first sort of three to six months. They, sometimes, I'll say eight weeks, it depends on the severity, but it's normally they push it out a little bit further than that or they'll look at someone's history and go actually they had a severe or multiple concussions in the past, so now we're seeing these symptoms which are different. So I think between 30 and 70% of people that have had concussion have sleep issues. So ongoing sleep issues is very common. Ongoing headaches, often visual disturbance like I've had, you know, some of my teenagers that I've had here and some of my older, when I say older patients, like get, sort of mid-forties who have got post-concussion syndrome, find that the words move on the page so they can't sit there and read a book.

We actually have a couple of optometrists that we refer to because there's some very specific testing in what they call optometrics around understanding that because there's, you know, a big percentage of people who end up with these optical issues, which makes sense, you know, given that the optic nerve runs through your brain. It can be ongoing dizziness, but sort of intermittent profound fatigue. Mental fatigue as well. Like a number of my teenagers they're down to one or two days a week at school because anything more than that, they've just got splitting migraines and they can't function. They can have changes in appetite. They can have ongoing nausea that just doesn't make any sense. I actually had that with a post-concussion syndrome patient who'd been going to the Brain Hub in Gladesville for in excess of 18 months.

And I know those guys quite well and they're like, she's got all these gut stuff that we just can't figure out. And it's nausea at night, throwing up, cannot keep breakfast down. And this is over a very long time after her symptoms. So we did a full process with her around gut repair as well as near infrared light and you know, hyperbaric oxygen therapy and she's like, do I feel like I'm like four months on? She's like, I'm 75% better and now we got her to the optometrist to do the next step for her. Sometimes it can be they just can't concentrate at school. They've got more memory issues than they had in the past. Depression and anxiety are almost par for the course and I wonder, you know, that's from the damage, but I think also because they're not operating at the way that they used to.

And also because they've got the sleep problems, often quite sensitive to light and noise. You know, they're just a different person. You know, it's not, if it's a teenager sometimes you'll see, you know, the kid that was school captain and captain of the rugby team suddenly turn into a depressive gamer who doesn't sleep and who stays in a dark room all the time and they no longer socialise and they're really struggling. So it's a big spectrum of symptoms and no one's going to have all of them, but people may have a number of them.

Wendy McLean (26:26): Yeah, definitely. And yeah, it must be heartbreaking. You know, having a personality change, the anxiety, the depression, and just losing your life.

Jo Grabyn (26:36): Yeah. Especially when it's your child who's in high school or I have a gentleman who's been coming here and he had to sell his business. He literally had to get signed off on TPD [total and permanent disability] because they didn't think there was anything that they could do to get his life back on track.

Wendy McLean (26:55): Oh yeah. That's heartbreaking. And I've certainly seen a friend's son who fell off a swing and basically had to learn to write again. He couldn't even write, spell his own name. So yeah, it's hard.

Jo Grabyn (27:08): It's really sad. And it's so rarely recognised because they didn't get diagnosed with the concussion in the first place. 

Wendy McLean (27:15): That's right. So we've talked about it a bit with the SPECT scan, but how else can we can diagnose post-concussion syndrome?

Jo Grabyn (27:29): There is no official criteria.

Wendy McLean (27:31): No. Is it, there's no biomarkers?

Jo Grabyn (27:34): So there are certain things that we look at in bloods. There are certain hormone tests. But as far as being able to scan and say this is a problem. So generally, what we are looking at is both the symptomatic picture, their concussion history or their history around head injury. Sometimes you've got to ask someone 10 different ways if they've had some sort of head trauma. You know, I mean I had a patient early on in this work for me and she was probably, she'd been my patient for about 18 months and kept getting these headaches and it was long before I had hyperbaric, and she said I think it was about the 18-month point. And she goes, oh my god, Jo, there's something I forgot to tell you. It's like, okay, please fill me in. Just before I met you, I was at friend's house and I tripped over my sandals on the way down the stairs and I fell, like I literally fell over and smacked my forehead on the corner of a concrete tile in their garden.

Wendy McLean (28:33): Oh my goodness.

Jo Grabyn (28:34): And she goes, and I must have got knocked out for like 10 minutes. And I'm like, so that might have been important. We may have needed to know about that quite a long time ago.

So this is why they always say there's so many other things that we need to take into consideration. So there are, you know, there is basic blood work that we look at. And most GPs are fairly willing, some of them not so much. America's a little bit more broadly thinking in what they'll let us get. But they are some of the really standard things. But other than that, sadly it's actually much more of a, I guess the very thorough history taking that we make. You know, it's naturopathically, we're taught how to do that. 

You know, GPs, they go, oh, you've got your 15, actually I've got seven minutes for you today. How much can you tell me in seven minutes? But it's not, again, don't get me wrong, I have great GPs that I work with. It's the system, you know, it doesn't allow doctors to spend the time that they need to be able to dig in and really understand more about the patient and what's gone on for them. So we have more that we can do in that space. And you do want to look at diet, you want to look at their sleep patterns and you want to look at potentially their genetic history, and their family history just about, you know, has anything else gone on? Because if you have a family history of mental health or dementia, then you've probably got a high chance, we know that anxiety is a higher risk.

Wendy McLean (30:10): Yeah, absolutely. And the case taking is absolutely critical, but, and then as you say that something might have happened when they were young and they just don't remember you know, if they were an infant, something could have happened.

Jo Grabyn (30:25): Well, I had a friend who, when her daughter was five weeks old, they had a nanny and the nanny accidentally dropped their child on the floor on her head, and she spent six months in hospital. But if that child comes to someone as an adult, she's not going to, she may not remember that. 

Wendy McLean (30:43): No, that's right.

Jo Grabyn (30:44): Which she might, a lot of people go, oh, but you know, it happened like way back and you’re going, mmm, yeah, that's it. Unfortunately, brain doesn't just heal by rest.

Wendy McLean (30:54): No, no, that's right.

Jo Grabyn (30:55): You need the nutrients back to enable that to happen.

Wendy McLean (31:00): Yeah. that's absolutely right. And I guess there's a little bit more awareness I think around concussion and post-concussion syndrome now, particularly through the sporting arena. And also then linking that with mental health. So I guess can you discuss some of the latest findings?

Jo Grabyn (31:27): It's, I think a lot of it's in the process of happening. So it's interesting because a lot of footballers, and I'm talking about, you know, all [football] codes are now donating their brains to science. You know, there's even been some AFL players in the last 12 months who have committed suicide and they did it in such a way that it wasn't going to affect their brain and they donated their brain to science and I find it really tragic that they got that bad. And it wasn't looked at, so there's, in America there's a lot more money to do these things, so you find there's probably, there is more research with CTE, which is more of an NFL thing. Our guys still get it. But I suppose it seems that was where it was really first brought to the forefront.

So there's a little bit of research in that space. But you know, often it's people donating their brain and, it's at that really molecular level at this point. Also in the States because they're doing a lot of work in the TBI space with the veterans and they have a much bigger military contingent to work on with that. You know, like one of the leaders in omega-3 therapy for brain recovery actually was a doctor in the US Army for 20 years. And his specialty in that space was TBI and IED [improvised explosive device] blast injuries. And he's now worked out the omega-3 levels that we need in the early days. And then even to the point that you can, if your kids are playing, you can give them a specific amount of an omega 3 throughout their school years while they're playing because it becomes more protective. So it's not going to stop a concussion. Hopefully it will reduce the severity of the symptoms. And you know, this is a guy who having spent that many years in it lets his kids play college football. 

So I'm like, if he's doing that, it must have some fairly serious support behind it.

Wendy McLean (33:23): Yeah, absolutely. Yeah. I think we're really only just touching the surface in Australia. 

Jo Grabyn (33:30): So I think a lot of it at the moment is more anecdotal than big published studies. You know, in PubMed there's some information from like 2013. There was a couple of interesting reviews actually posted in 2021. But there's still more of it is around, you know, we need more information, we need to dig further. It's about trying to find the living populations, I guess, rather than going, oh, we are digging through these brains, and this is what we're finding. You know, that was how the Alzheimer's stuff started.

Wendy McLean (34:02): Yeah. And it's interesting because I think I was reading something, CTE was first identified, I think it was like in the 1920s and originally they just thought it was in boxers, so we've come a bit of away from there, but certainly just touching the surface.

Jo Grabyn (34:19): Well, especially because, you think it really was brought out in America with the NFL. And you think about the industry that is NFL and even think about, you know, in Australia, the industry that is rugby league and NRL and AFL and it's not, we don't want to stop people playing sport, you know, it's not about that. But mind you, if you speak to someone like Daniel Amen, he's like, if you need to wear a helmet in sport, don’t, just don’t.

Go and play tennis or something. But they're a national institution, so it's how do we just learn to be more vigilant around what's happening and how do we actually do more preventative work and then if it happens, how do we get onto it as quickly as possible and then look at programs that will help people rebuild as quickly as possible.

Wendy McLean (35:10):Absolutely. That's it. So I guess there's, we've looked at the mental health aspects that can be associated with brain injuries, but what are some of the other things? So particularly you've mentioned links with dementia.

Jo Grabyn (35:26): Dementia and cognitive decline. You know, when you consider the fact that post-concussion syndrome, memory loss, concentration issues, focus, all of those types of basics come into play. We see patients with these conditions developing cognitive decline much earlier. It's, I've had, I think my youngest really severe cognitive decline patient was 54. And again, the questions around concussion, like he took, he was, you know, quite a profound sports person. He had been a coach of Olympic teams, he'd been an executive coach. And it was only after a couple of months that I actually had taken him to another practitioner to do more structural assessment and integrity. And he sat there and he goes, oh yeah, when I was 20, I actually, I did a pole vault at university and I missed the mattress and landed on my head on the asphalt.

Oh, how did we not know about this? You know? So this is where we do see these issues much earlier and it's not going to be, you know, there's so many, you know, dementia is such a spectrum. So from very mild cognitive impairment or even subjective cognitive impairment when we're going, God damn my brain just does not work the way that it used to. And often then we are looked at, you know, GPs in their space and again, me not picking on them, this is actually just part of how the system works. You're like, oh, you're just really stressed.

Let's not dig any deeper. Let's just, you know, why you just lost your job or you're a single mum or you just had a divorce. It's, these things are played down, and I think we need to be digging deeper to go, how do we help these people earlier and give them as much quality of life mentally and emotionally as possible. You can, you know, unless if you want to stick your head in the sand, go ahead. But know that that means that you're not going to be doing anything to help yourself. 

Wendy McLean (37:25): Absolutely. So that leads on nicely then to what can we do? What is your approach?

Jo Grabyn (37:34): Oh, actually let me just flag one other thing. This has been really recent for me to realise this, and I've seen it in two patients with post-concussion syndrome, and that is an early development of epilepsy, which actually does come off the back of post-concussion syndrome in some people. It's definitely not everyone. It's definitely in the more severe cases. Sometimes they're much milder forms of epilepsy. But I did see it in that gentleman that I just mentioned who is 54. I had another patient who's actually about the same age as me. And her first really serious concussion was at 20, and she had another one about three or four years ago. And it was actually really downplayed she had an accident. She bounced off on a motorbike, she bounced off the bonnet of the car, was sent home three hours later going, no, you’re good. And now a couple years on from that has developed epilepsy. And then I've got another patient who played rugby. He's about 60, but he played rugby right through until like his late thirties. He also was a boxer through his teen years, and he grew up in quite a challenging household where there was a lot of abuse. So, you know, that's one of those things to look out for sometimes. If that's a sudden diagnosis and everyone's going, oh, where on earth did that come from? You know, we need to be thinking bigger picture and much deeper history to understand. Sorry about that.

Wendy McLean (39:12): Yeah, that's a great point. And yeah, I actually had just come across that myself and I guess that it makes sense. So yeah, again, just comes down to that detailed thorough case taking and as you say, asking the same question ten different ways.

Jo Grabyn (39:31): Yeah. And I think we're better at that than sort of any other area of healthcare.

Wendy McLean (39:37): Absolutely agree.

Jo Grabyn (39:38): We own it, that we're good at it and we have time. Don't do it ten times, you know, ten different ways in the first consult. Each time try to find a different approach. To be able to bring the conversation up and, you know, develop the story.

Wendy McLean (39:52): Yeah. That's great advice. And it's similar looking at things like environmental exposures as well. That's something you need to be very thorough about as well. So, yeah. So what can we do? What's your approach?

Jo Grabyn (40:11): So obviously the first step is taking a really thorough history and find out what's going on. There’s always order a fairly extensive panel of bloods. Depending on it's, it's always going to be personalised. So we will look at the gut function, the majority of my patients, I would use a GI map. And sometimes if it's really messy, we may go to a GI360. There's an omega-3 index that is a no-brainer, pardon the pun. It's if we do not know what someone's omega-3 levels look like until we look. You know, they'll go I eat fish three times a week. You're like, that's nice. You know, but it's like, how long have you been doing that? If you think about someone who hated fish as a kid, you know, or they only started, you know, they're 45 and they started eating salmon three weeks ago.

But they're like, no, no, I eat it three times a day now. Like or, or you know, I often see people that have had you know, their whole life, they've eaten grained meat. I mean, let's be honest, we've really only had access to grass fed meat in probably the last five to 10 years. Or likely and all of that grain meat is going to load up your omega six. The other thing that I'll always do is at least a DNA health panel so I can understand a little bit like what is that patient's APOE4 status? You know, what does their inflammation panel look like? What does their methylation look like? What does their detox look like? And then can they absorb all the appropriate nutrients? And so the testing, I think you don't have to go all out, you still go to choose what's appropriate.

But I think that those things, if you get an absolute baseline would be the bloods and the omega-3. People can't afford more than that, then you normally spend about a month really working on their nutritional status with some quite specific nutrients. You know, things like high dose omega-3, but getting really fussy about what you're using. NAC, vitamin D, curcumin. I actually have like a whole panel of what we use. You know, vitamin C, MCT, branched chain amino acids. I actually always add CDP [cytidine diphosphate choline] now. Actually, let me just add, unless someone has epilepsy, because there's a little bit of research that's looking in that maybe it's not the best thing to do for someone. And we would do that probably for four weeks before we would start thinking about adding adjunctive therapies.

You might send them for a structural alignment in that time to make sure there's nothing going on with their neck that's adding to their symptoms. I wouldn't be going down the optometrics track until much further into treatment. You definitely want to make some major dietary changes if, especially if you've got a teenager who eats a standard Australian diet. You want them absolute bare minimum, get them off gluten, off alcohol. And get their sugars as low as possible. So get them as close to keto, at least nutritional keto overnight as you can. And exogenous ketones are actually recommended in that first month as well, just to make sure that you're giving their brain something you can use. Exercise is still important. You know, like it used to be the old thing, oh, now just go and sit in the corner and then don't do anything for the next however long.

Now what we look at is providing, it's not going to make their symptoms worse they need to move every day. And normally like you would push it until you start to get symptoms and then pull back by 20 to 30%. Your brain needs oxygen and it needs the blood flow. It's actually important to get those things involved. For me, because I have access to it, I will use hyperbaric if the patient is financially in a position to do so. And we would do that fairly concentrated for, you know, the research shows anywhere from 40 to 120 hours. But we would normally try and get people to 40 hours fairly quickly. But even if you're looking at 20 to 30, it really depends on symptoms. The other thing is your near infrared light therapy, so something like Vielight headsets they have, they actually have a version which we stock here called Neuro Duo. So it covers both the alpha and gamma waves within the brain. So gamma gives you the executive function. And the alpha actually really helps with that stress relief, that anxiety, the sleep issues, those types of things. So you just, you're giving the brain lots of different nutrients, you know, from the type that we ingest to the right kind of light because we are, you know, ourselves are pretty malilluminated now, you know, we get malnourished, but ourselves get malilluminated. And then also, you know, you're putting in, you're helping your oxygen get to places that it didn't otherwise get to.

Wendy McLean (45:37): Yeah, definitely. And is there any type of exercise that is better? So would aerobic exercise be better or there's no research either way at the moment?

Jo Grabyn (45:46): There's not necessarily research either way. It's more about what they can cope with. I find generally walking is good. At least if you get someone who is a sports person and they are super fit, if they go heavy on their weights, they're going to know really quickly. I had a young guy here through the last set of school holidays. He actually just put up a testimonial for us and he got a hit, a major hit during a rugby match. And the hardest thing was getting a 17, about to turn 18 year old off alcohol for the school holidays. And he came, he knows that I train and so he would ask me about that and he's like, oh Jo, I just did my first my first weight training session and oh, I thought I was going to be sick. And he goes, I haven't had that for a really long time. Like, what were you doing? He's like, oh, compound stuff. And you know, just maximum five reps. I'm like, max five reps. I'm like, dude, that is like crazy heavy. Your brain feels like it's going to explode. So can we just back that off to more endurance and tempo stuff so that we are not having a brain explosion while you're actually training yet?

And so he did, he went back down to sort of more like sets of 12 to 15 for another week or two. Maybe not so much in the compound. Maybe go a little bit more isolation. But still go for a swim, go for a surf. Some people you don't suggest they go for a surf because they may actually have got post-concussion syndrome by coming off, getting a smack in the head off the board, which I've had a few of them. So there's all different things that you've got to take into consideration, but there's no rule of thumb. It's not like, you know, with PTSD for example, there's quite a specific prescription. Whether it's anxiety or depression. And then with depression we know how much resistance training we need to do with the brain when it's unhappy and it's swollen and it's like kind of a bit how you're going. You really just need to work personally with that patient around what they like doing, what they've been able to do. And you know, finding the threshold until you can start to increase it marginally as you go.

Wendy McLean (48:03): Yeah, absolutely. And I imagine that it must be hard for some people when, you know, they've been playing say soccer for 10 years and then you tell them perhaps you really shouldn't go on playing soccer. You know, and so you've got that education process as well that you've got to do with them.

Jo Grabyn (48:23): Yeah. It's really hard. And I think that's where, especially if they're quite serious or they want or their plan is to become a serious sports person. Someone who really wants, like, that young boy that I spoke about before who's a defender, he really wants to be a professional soccer player, you know, and I've spoken to his mum and said I really think you need to get him to a sports psychologist. Like he's already at risk, already has a lot of other symptoms that the average concussion patient doesn't have.

And it's quite heartbreaking for him to have to consider that. So he's, you can't stop them. It's just, you know, if he wants to go out and do it. But, you know, in a sense you sort of have to be the voice of reason of, you know, you're 17. You want to be here in 30 years and I know that's what your dream was. And I kind of know that's what your dream is and it's, I'm not trying to stop that. I'm just looking at what your body may be capable of healing, to move forward. 

I had a young girl who's an MMA fighter and when she hit post-concussion syndrome and had two years of treatment and it took us until two and a half years to get her to feel pretty normal again. And I, like I never told her not to fight. I let her come to her own conclusion on that. I just kept talking about all of the potential issues and the young guy from St Augustine’s I didn't tell him not to play anymore. But he, on the game that he got hit, he had been moved into the scrum instead of being on the wing and he got knocked out cold with an elbow on the ground. I'm like, can I just check in? When you go back after the school holidays, are you going back to the scrum or to the wing? And over the time that he'd been coming, we'd been talking about some of the issues, talking about when he finished HSC, what he wanted to be doing and by really exploring what he wanted his life to look like after, he made the decision on his own. It was like when I found out he was going back to play, I'm like, dude, please don't get hit this weekend. Like, your mum's going to have a heart attack. It's, you know, please just stay on the outside of the field. But he was a boy that really has his head screwed on well. And he's got lots of other sporting things that he does, he’s into life-saving and so it wasn't sort of his be all and end-all. And I think sometimes it's just about opening the door on lots of different things, with various conversations. And hopefully they'll find that space for themselves. But if they ask me honestly, I'll tell them honestly. 

Wendy McLean (51:14): Yep. And that's it. And we can just give them the facts, the education and empower them to make the ultimately the best decision for themselves. 

Jo Grabyn (51:22): There's also some really good books. So there's the Michael Lewis that I mentioned about the omega-3. He's actually got a book, it's called ‘When Brains Collide’, and it's like what every athlete and parent should know about the prevention and treatment of concussion and head injuries.

And so it's really written for the lay person and it's written for the parents. It's written for the players if they're at high school, it's written for the coaches. It's interesting how much people like to keep their head in the sand. Because this patient's mum, I showed it to her and she went off and bought a copy and she'd been trying to speak to other parents in his team about what had happened to him. And she'd read this book and it really helped show her the things that they needed to be doing to look after the kids. And she's just, like she said, the amount of defense and, you know, ostrich treatment, the head in the sand stuff. No, no, no, we're good. We're good. Everything's fine. We know what we're doing. So there are resources out there, but people have to be willing to take a look.

Wendy McLean (52:23): I just want to touch back on diet. Is there any specific dietary pattern that you recommend? Or is it really just going back to first principles and reducing the sugar, processed foods and just sticking to whole foods?

Jo Grabyn (52:41): I think it's whole foods, but it's, it needs to be heading in the direction of a keto diet. You know, so because our brain needs that. And at that point it can't run on sugar. So to get, we also want to keep the insulin levels low. Because there's a whole lot of metabolic dysregulation going on, so it's, a whole food keto diet, I would say particularly in that first month. And you know, we know that gluten inflames the gut, so it also inflames the brain. I see that whether it's brain fog from chronic stress or from something like Hashimoto’s through to the memory issues that we get with concussion. It's gluten really, at least for the first, I would say three or four months should be minimalised, if not avoided. And also like you've got to avoid alcohol. You know, alcohol reduces blood flow in the brain. I see it with my dementia patients when they come off alcohol for a period of time, and then I can tell the next day when they've had a drink because all of a sudden their cognition has just gone sideways, overnight. So it's about giving the brain an opportunity to heal, and if you keep putting the things in that are going to inflame it or reduce its capacity to get the nutrients it needs then, you know, it's just not helpful.

Wendy McLean (54:06): Yeah, absolutely. And what about caffeine? Is there any evidence?

Jo Grabyn (54:10): Caffeine…it's not about, no. But it's about, you know, don't be stupid about it. You'd always want to keep it to where possible one, but maximum two a day, because again, caffeine reduces blood flow to the brain. So I've had patients, dementia and Alzheimer's patients go, but I saw this research, it said that, you know, up to six coffees a day is a really good thing for me. I'm like, oh, dear. I'm like, I understand that those things are out there. However, there is other research that suggests that maybe for your brain to work really well that's not what you want to do. And especially like if you've got someone who has anxiety. You're just going really? Sure? It's not a no, but again, it's about being smart. I would say, to me, gluten and alcohol are black and white; caffeine is be smart about it.

Wendy McLean (55:08): Yeah. That makes sense.

Jo Grabyn (55:10): You know, and just see how you feel. Particularly like if your sleep's really bad and you know, up to 70% of people are going to have sleep problems and sleep is one of the most important things. You know, like in, in the early days after a concussion, someone who's had a concussion needs an extra one to two hour sleep every night to give its brain, you know, give their brain a chance to actually heal at that time. Which made, to be honest, made so much more sense to me after having spent that six weeks in ICU with my dad. Because I said to them, I'm like, why have you got him in a coma? This is a long time ago. I was totally not aware and there wasn't much space, much information in the space. And they're like, well Jo, you know how when you break an arm or break a leg, you put a cast on it.

With your brain, as soon as there's a noise or a smell or someone touches you your brain wakes up and goes, oh, there's stimulation, there's something going on. And the only way to stop that stimulation, the only way to put your brain in a cast per se, is to block it all out. You know, so sleep's the closest that we can get in a natural environment for that.

Wendy McLean (56:16): Yeah, absolutely. And are there any specific nutritionals that you might use or herbs or anything to assist with the sleep in really bad cases?

Jo Grabyn (56:27): I would probably go with something like glycine. I just try to keep things gentle and simple. That would probably be like, obviously we want everyone on magnesium of course which is important anyway. So I would, in that case, I would actually use magnesium L-threonate and some glycine. If there's a lot of anxiety going on, I may use some L-theanine.

But other than that, I try not to push it. I'd rather err on the side of caution and add things as we need to. And probably the one other treatment protocol or process that I haven't spoken about is neurofeedback. But really if people are, are experiencing some fairly sort of heavy mental health type issues off the back of the brain injury, then neurofeedback, but again, down the track. And you still want to make sure that the brain's getting the right nutrients through that, like your omega-3, NAC, CDP, that kind of thing. 

Wendy McLean (57:33): Absolutely. And so it sounds like, you know, you work as part of a team, like you can refer out to other specialists. Like you were saying if they need to look at the physical, you know, send them to a chiropractor, an osteopath, and you've touched on some therapies you use like the hyperbaric. Are there any other therapies or modalities that you might use as well?

Jo Grabyn (58:00): I think between the ones that I've sort of touched on, hyperbaric is a big one. There's, you know, if people want to dig into the research, there's an amazing US site called hyperbaric experts.com. Those guys employ a medical student to actually trawl PubMed for all the research that comes out about hyperbaric. And so you can actually go into it, there's a latest research tab, you click on it and it brings up every area that's ever actually been studied in hyperbaric. And then you go into that and they've got all the abstracts and then you can click through to pub. So it's a fabulous resource if they’re interested.

Wendy McLean (58:36): Yeah. Fantastic.

Jo Grabyn (58:38): The optometrics is a new one for me. I actually only probably six months ago met an optometrist that's fabulous and specialises, but even things like meditation and breath work become really important in the stress time of it. Meditation will help reduce inflammation in the brain. You know, sometimes we have the VieLight for the near infrared light for the brain, but then there's also a system called Brain Tap, which I found in the US in June, and I'm looking at bringing that in. And then some people have heard of a system called True Calm, which is more of a meditation thing that also has GABA patches that you stick on. 

So there's lots of things like that. And then if you, depending if there's dizziness and balance issues there's an amazing practitioner over in Gladesville who's set up a whole clinic over there that they do a lot of that more complex neuroscience like, or the functional neuroscience work to help people with those types of issues. And there's also a new clinic in Rosebery that they do, let's just say it's a much higher end clinic. They're fabulous, but you've got to have a lot of money in the bank to be able to do it. Charlie Teo is part of that space.

And they've done some really amazing work there, but it’s definitely that high socioeconomic, yeah. Like you, I think your starting price is about 7,500 to 10,000 dollars.

Wendy McLean (1:00:20): Okay. Yeah. But, you know, at least there, there's so much we can do that is, accessible to everybody pretty much.

Jo Grabyn (1:00:31): That's what I think.  To me, that's why it was really important to have this conversation with you, Wendy, because I think that there's a lot of us don’t know that we can do things. We also don't know that there's certain question, there's more questions that we should be asking. And there's a lot of information. There's, you know, there's some great books, you know, like Kabran Chapek who actually runs one of the Amen Clinics, he's a naturopathic doctor in Oregon and he's written a book he's one, sorry, I've got a pile of books, he's got one on concussion rescue. And it makes it very tangible for people to know that there's more that they can do, but I think it's a good one for pracs to dig into and understand a little bit more.

Wendy McLean (1:01:13): Absolutely. I mean, you've certainly opened my eyes on this topic and, you've provided so many great resources that practitioners and patients can kind of reach out, look at themselves. Do you have any other kind of takeaway messages that you want to share with the listeners?

Jo Grabyn (1:01:36): I think it's about looking. It's about getting really deep and just helping people understand that there are ways to help them get better. We may not be able to fix it. But if we can improve their, their quality of life and their symptoms profoundly in fairly simple ways but also help them understand that it's a journey. You know, it's, the majority of people are looking at least six months treatment. And then they're going to want to look at a maintenance schedule around their nutritional supplementation and helping them really understand, become very aware, but very body aware around when, you know, when they do eat the wrong thing. Or they do, you know, like silly season is coming up, right. So you've got all these people who may go alcohol free for six months and then all of a sudden, oh, but there was this event and there was that event, and then they hit January and they're like, I can't see straight, I can't think clearly. Like, but my brain's like totally messed up. Why? You know, so help them get back on track.

And know that there's a lot, but there's loads of resource out there for patients and pracs if they dig a bit.

Wendy McLean (1:02:54): Yeah, absolutely. Well, Jo, thank you so much. I mean, you've just shared so much great information, but really you've provided a sense of hope, I think, and I hope, and I think our listeners will feel like they're not alone. There are options. There's some quite simple things that can be done to nurture them and get their life back.

Jo Grabyn (1:03:16): I think that's my goal, right? My goal on WHOLE Health Clinic is actually about every part of us. You know, it's the physical, mental, emotional, environmental, spiritual relationships. All of those things. And it's important to me to look at that for my patients. And I think hope is one of the biggest things that we can give our patients, where often the medical system it, it just doesn't. You know, I get patients diagnosed with dementia and they're, you know, off filling out a piece of paper sometimes not even by scans and things, and the doctor just goes, I'm very sorry. You best get your affairs in order. And you're just sitting there going, what are you doing to these people? I think it's a view that we bring that, you know, other modalities don't. So I think the big thing is to realise that we have so much to offer. And, you know, your patients can, you know, thrive off track of some really simple interventions.

Wendy McLean (1:04:14): Absolutely. Well, thank you again, Jo. Thank you so much. And also thanks to our listeners for tuning in today. We really do appreciate your support and feel free to leave us a review. We'd love to hear your feedback. Thank you.

 

Website: Bounce Matters - WHOLE Health Clinic

LinkedIn:  /jograbyn

Instagram: bouncematters

Facebook: /BM1Brain1BodyforLife